退行性腰椎椎管狭窄伴或不伴腰椎滑脱患者椎旁肌退变的差异及其与关节突关节退变的相关性

Degeneration of paraspinal muscles in degenerative lumbar spinal stenosis with or without spondylolisthesis and its correlation with degeneration of lumbar facet joints

目的分析退行性腰椎椎管狭窄(degenerative lumbar spinal stenosis,DLSS)伴或不伴腰椎滑脱患者椎旁肌退变的差异及其与腰椎关节突关节退变的相关性。方法回顾性分析2021年1月至2023年4月在湖州市中心医院68例接受手术治疗DLSS患者的病历资料,男22例、女46例,年龄(69.7±5.9)岁(范围56~80岁)。单纯DLSS 35例(DLSS组),男13例、女22例,年龄(68.5±5.9)岁(范围56~80岁);DLSS合并腰椎滑脱(degenerative spondylolisthesis,DS)患者33例(DLSS+DS组),男9例、女24例,年龄(70.9±5.7)岁(范围58~80岁)。收集所有患者L 3~S 1各节段椎间盘水平的轴位MRI,应用ImageJ软件测量竖脊肌、多裂肌横截面积(cross sectional area,CSA)和脂肪浸润面积百分比(percentage of fat infiltration area,FIA%)。应用Surgimap软件测量关节突关节角(facet joint angle,FJA)、关节突关节骨赘(facet overhang,FO)长度和关节突关节积液(facet effusion,FE)宽度,并分析与椎旁肌CSA和FIA%的相关性。结果DLSS+DS组FJA、FO分别为50.16°±11.08°、(7.67±2.25)mm,均大于DLSS组的43.51°±7.75°和(3.88±1.98)mm(P<0.05)。DLSS+DS组L 3,4、L 4,5、L 5S 1节段多裂肌CSA分别为(576.66±112.70)mm 2、(782.72±141.49)mm 2和(817.88±185.22)mm 2,均小于DLSS组的(647.37±165.44)mm 2、(881.20±202.10)mm 2和(995.06±211.25)mm 2(P<0.05);DLSS+DS组多裂肌FIA%分别为18.04%±5.88%、19.67%±5.78%和19.31%±8.61%,均大于DLSS组的9.85%±4.39%、12.27%±3.70%和14.65%±3.82%(P<0.05);DLSS+DS组竖脊肌FIA%分别为11.47%±5.14%、14.84%±6.15%和20.82%±7.41%,均大于DLSS组的6.27%±2.83%、10.81%±4.84%和16.17%±5.88%(P<0.05);而两组患者竖脊肌CSA的差异均无统计学意义(P>0.05)。两组患者L 3,4、L 4,5、L 5S 1节段多裂肌CSA与FJA、FO呈负相关(r=-0.318,P=0.008;r=-0.381,P=0.001;r=-0.439,P<0.001;r=-0.290,P=0.016;r=-0.315,P=0.009;r=-0.479,P<0.001);L 3,4、L 4,5节段竖脊肌FIA%和L 4,5、L 5S 1节段多裂肌FIA%与FJA呈正相关(r=0.352,P=0.003;r=0.344,P=0.004;r=0.300,P=0.013;r=0.359,P=0.003);L 3,4、L 4,5、L 5S 1节段竖脊肌FIA%和L 3,4、L 4,5节段多裂肌FIA%与FO呈正相关(r=0.409,P=0.001;r=0.248,P=0.042;r=0.277,P=0.022;r=0.500,P<0.001;r=0.447,P<0.001);L 3~S 1各节段竖脊肌和多裂肌CSA和FIA%与FE均无相关性。FJA与FO呈正相关(r=0.369,P=0.002),FE与FJA、FO均无相关性。结论与单纯DLSS患者相比,DLSS合并DS患者椎旁肌萎缩程度更严重,关节突关节方向更矢状化且骨关节炎更严重。FJA和FO长度较大的DLSS患者椎旁肌萎缩更严重。

ObjectiveTo analyze the differences in paraspinal muscles between patients with degenerative lumbar spinal stenosis(DLSS)with or without spondylolisthesis and to assess the correlation between these differences and lumbar facet joint degeneration.MethodsThe data of 68 patients with DLSS who underwent surgical treatment in our hospital from January 2021 to April 2023 was retrospectively analyzed.Of these,22 were male(32.4%)and 46 were female(67.6%),with an average age of 69.7±5.9 years(range:56-80 years).The DLSS group included 35 patients without spondylolisthesis[13 males(37.1%)and 22 females(62.9%)],average age 68.5±5.9 years(range:56-80 years),while the DLSS+degenerative spondylolisthesis(DS)group included 33 patients with spondylolisthesis[9 males(27.3%)and 24 females(72.7%)],average age 70.9±5.7 years(range:58-80 years).Magnetic resonance imaging(MRI)scans of the L 3-S 1 intervertebral disc levels were collected from all patients.Using ImageJ software,the cross-sectional area(CSA)and percentage of fat infiltration area(FIA%)of the erector spinae and multifidus muscles were measured.Additionally,the facet joint angle(FJA),facet overhang(FO),and facet effusion(FE)were evaluated using Surgimap software,and their correlation with CSA and FIA%of the paraspinal muscles was analyzed.ResultsThe FJA and FO in the DLSS+DS group(50.16°±11.08°and 7.67±2.25 mm)were significantly larger than those in the DLSS group(43.51°±7.75°and 3.88±1.98 mm)(P<0.05).However,differences in FE between the two groups were not statistically significant.The cross-sectional areas of the multifidus muscles at L 3,4,L 4,5,and L 5S 1 in the DLSS+DS group(576.66±112.70 mm 2,,782.72±141.49 mm 2,and 817.88±185.22 mm 2,,respectively)were significantly smaller than those in the DLSS group(647.37±165.44 mm 2,,881.20±202.10 mm 2,,and 995.06±211.25 mm 2,,respectively)(P<0.05).The FIA%of the erector spinae at L 3,4,L 4,5,and L 5S 1 in the DLSS+DS group(11.47%±5.14%,14.84%±6.15%,20.82%±7.41%)were significantly higher than those in the DLSS group(6.27%±2.83%,10.81%±4.84%,16.17%±5.88%)(P<0.05).Similarly,the FIA%of the multifidus muscles at L 3,4,L 4,5,and L 5S 1 in the DLSS+DS group(18.04%±5.88%,19.67%±5.78%,19.31%±8.61%)were significantly higher than those in the DLSS group(9.85%±4.39%,12.27%±3.70%,14.65%±3.82%)(P<0.05).No statistically significant differences were found in the CSA of the erector spinae at these levels between the two groups.The CSA of the multifidus muscles at L 3,4,L 4,5,and L 5S 1 in both groups were negatively correlated with FJA and FO(r=-0.318,P=0.008;r=-0.381,P=0.001;r=-0.439,P<0.001;r=-0.290,P=0.016;r=-0.315,P=0.009;r=-0.479,P<0.001).The FIA%of the erector spinae at L 3,4,L 4,5,and the multifidus muscles at L 4,5 and L 5S 1 were positively correlated with FJA(r=0.352,P=0.003;r=0.344,P=0.004;r=0.300,P=0.013;r=0.359,P=0.003).Additionally,the FIA%of the erector spinae at L 3,4,L 4,5,and L 5S 1,and the multifidus muscles at L 3,4 and L 4,5 were positively correlated with FO(r=0.409,P=0.001;r=0.248,P=0.042;r=0.277,P=0.022;r=0.500,P<0.001;r=0.447,P<0.001).There was no correlation between FE and CSA or FIA%of the erector spinae and multifidus muscles at L 3,4,L 4,5,and L 5S 1 in either group.Furthermore,FJA was positively correlated with FO(r=0.369,P=0.002),but no correlation was observed between FE and FJA or FO.ConclusionCompared to patients with lumbar spinal stenosis,those with degenerative lumbar spinal stenosis with spondylolisthesis exhibit more severe paraspinal muscle atrophy,a more sagittal orientation of the facet joints,and a higher degree of facet joint osteoarthritis.Patients with larger FJA and FO show more severe paraspinal muscle atrophy.